“Focusing on constantly improving emergency care that is available 24/7, 365 days of the year is essential for any sustainable healthcare gain,” he added.

Dr Razzak, who is pioneer of Pakistan’s first emergency medicine residency programme, was speaking at the fourth Annual Emergency Medicine Conference (AEMC) at the Aga Khan University which was organized in collaboration with the National Institutes of Health, Johns Hopkins University and the Fogarty JHU-Pak International Collaborative Trauma and Injury Research Training Programme.

Highlighting the importance of trained emergency physicians, Dr Razzak said that though “Pakistan needs 15,000–30,000 trained emergency physicians today, we are graduating just 6–10 emergency doctors a year with only two programmes in the country and hence we need to find ways to fill this gap through opening other programmes and finding ways to train people through shorter curricula.”

This year’s conference focused on integrating clinical care and public health in emergency medicine. Under this wide umbrella were a variety of sessions from performance and predictors of emergency care to the basics of care physiology.

Dr Adnan Hyder, professor of international health and director, International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, emphasized the global paradigm shift in emergency medicine and the need to integrate public health approaches to improve outcomes. He urged that a national task-force be set up to develop an innovative road map to maximize the impact of emergency care in Pakistan.Perhaps the strongest indicator for the need to revamp the emergency medicine (EM) system and move towards a holistic, integrated approach was the heat wave crisis to strike Karachi this year.

“The number of patients affected by the heat wave was unprecedented and the current emergency care set-up was not adequately equipped to deal with this load,” said Dr Munawar Khursheed, assistant professor, AKU department of emergency medicine, during a panel discussion on experiences of the heat-related emergencies in Karachi.

“On June 21, we triaged more than 300 patients and on subsequent days hospital occupancy stood at 94 per cent. Not a single bed was available in the ICU or SICU,” he added. “And this was the similar situation in all emergency departments (EDs) in the city.”

“We have dealt with women in depressive stupors to those over-battered and beyond recognition. Even though you can see the physical evidence, the women will deny the abuse. They will rarely admit to what has happened,” said Dr Khushro Shamim, instructor, department of emergency medicine, AKU, in his talk on physical violence on women. “The usual response that we hear is I fell down.”

“As part of the healthcare system, the emergency department has a role in identification, reporting and management of cases of violence against women,” said Dr Shamim.

Dr Yasmin Zaidi, director of the Islamabad-based Center of Gender and Policy Studies, said standardized indicators are the need of the hour for any research on gender-based violence to be representative and reproducible.

She also shared initiatives taken by the National Commission on the Status of Women to develop Pakistan-specific standardized indicators on violence against women.

Dr Asad I Mian, associate professor and director of paediatric emergency medicine, AKU and a key organizer of AEMC 2015, gave an overview of paediatric emergency medicine in Pakistan.

“There is a need to reinforce paediatric trauma management services in EDs, including screening for potential physical, sexual and psychological abuse,” said Dr Mian. “From a public health perspective, primary prevention of child injury, like increasing safety in homes, schools and playgrounds, is really important. All emergency rooms where kids are being seen need to be child-friendly.”